As-needed Use of Benzodiazepines in Managing Clinical Anxiety: Incidence and Implications
Bibliographic record
Abstract
Benzodiazepines (BZs) have been widely investigated in terms of clinical efficacy, factors underlying dependence, associated cognitive impairments, and interactions with psychotherapy for anxiety control. However, few studies have systematically considered manner of BZ administration in relation to these variables. Studies of chronic BZ users indicate that as-needed or p.r.n. use is a very common practice, increases with chronicity of BZ use, and is preferred compared to regularly scheduled BZ administration. Moreover, a recent study of physician prescription practices indicated that p.r.n. BZ use is a commonly recommended BZ use regimen for anxiety disorder management. Physician advocates of p.r.n. BZ prescriptions for anxiety disorders cite enhanced patient control over symptoms, facilitation of exposure to fear-provoking situations, and reduced frequency of use as rationales supporting this practice. Available data however, do not consistently support these hypothesized advantages of p.r.n. BZ use. And in general, findings from different investigations relevant to this question suggest that p.r.n. BZ administration may be associated with increased patient preference for BZs over placebo, continued use, and greater impairment on cognitive factors associated with positive long-term anxiety management. Ironically, p.r.n. BZ administration may also be associated with reduced anxiolytic efficacy over time. These suggestive findings argue for greater systematic investigation of manner of BZ administration as an important medication use parameter. Such investigations may also yield practical guidelines for navigating BZ discontinuation and promoting more successful long-term management of anxiety.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".